Registration – Holland Church Nebraska

Child's Name*

First Last

Date of Birth*

MM

DD

YYYY

Grade child will enter this fall*

Gender

Allergies

Anything else we should know about your child?

Address*

Street Address City State ZIP Code

Parent/Guardian*

First Last

Phone Number (Text)*

Email Address*

Additional Parent/Guardian

First Last

Phone Number (Text)

Email Address

Emergency Contact*

Emergency Contact (other than parent)

Phone Number

Person(s) allowed to pick up child other than parent(s)

Home Church

Sibling(s) Attending

List any siblings of this child that will be attending VBS. Please also submit registration forms for each additional child.

May we take pictures of your child to use on Holland's Facebook page & website?*

Yes

No

May we take pictures of your child to use in slide presentations in our church?*

Yes

No

How did you hear about VBS at Holland Church?

Comments

This field is for validation purposes and should be left unchanged.

VBS Registration